The HIV Epidemic Among MSM is Still Expanding

A NYAS conference shows that there is much work to be done.

Published Tuesday, December 18, 2012

On Friday, December 7, the Johns
Hopkins Bloomberg School of Public Health and The New York Academy of Sciences (NYAS)
hosted a half-day conference focused on the
HIV epidemic among men who have sex with men (MSM). The conference—co-sponsored
by amfAR—highlighted groundbreaking work by eminent researchers at Johns
Hopkins and elsewhere, including Drs. Chris Beyrer and Stefan Baral of Johns Hopkins, Dr. Kenneth Mayer of Harvard Medical
School, Gregorio Millett of the Centers for Disease Control and
Prevention (CDC), and amfAR Vice President and Director of Public Policy Chris
Collins.

Held
at NYAS’s offices in lower Manhattan, the conference—titled New Paradigms of
Risk and Protection: Understanding the HIV Epidemics Among Gay and Bisexual Men—was
born from a July 2012 themed issue of British
journal The Lancet that focused on HIV in MSM. The Lancet series was spearheaded by Dr.
Beyrer, who assembled what he called a “dream team” of editors. Dr. Beyrer also
acted as moderator for the conference, introducing the theme of the day:

“While
the global trajectory of HIV in so many places and in so many populations,
happily, is in decline,” said Dr. Beyrer, “that is not true for men who have
sex with men. This is one of the relatively uncommon components of global AIDS
that’s still expanding. It’s happening in rich countries and poor countries.
It’s happening where MSM face criminal penalty, social stigma, and sanction,
and it’s happening in places like France, where they don’t.”

“The bottom line is that with current
technologies and tools that we have in hand, we can have an enormous impact on
these epidemics…But we’re not there yet.”

One of the key speakers at the
conference was Gregorio Millett, senior behavioral scientist in the Division of
HIV/AIDS Prevention (DHAP) at CDC and a former senior policy advisor in the
White House Office of National AIDS Policy, where he was one of the principal
writers of the President’s
National HIV/AIDS Strategy. Millett was the lead researcher on twopapers in The Lancet issue, and
he gave a riveting talk on his work looking at the growing HIV epidemic among
black MSM internationally and in the U.S.

“When
you look at the HIV epidemic in the United States, most new infections that
take place are among men who have sex with men,” said Millett “They are only two
percent of the population but comprised about 61 percent of new HIV infections
in 2009 (and a similar number for 2010).”

“There
is also a race and ethnicity dynamic, with most of the new infections taking
place among Latino and African Americans—primarily African Americans,” said
Millett. “African American men who have sex with men are certainly the
epicenter of the HIV epidemic in the United States.”

Citing
the HPTN 061 study announced
during the 2012
International AIDS Conference held in Washington, D.C., in July, Millet
noted that the incidence rate for African American gay men was found to be
astoundingly high at three percent, and the rate for young African American gay
men was double that number. “There are very few populations in the U.S. where
you see incidence rates as high as that,” he said. “It certainly rivals
incidence rates that we find in more generalized epidemics around the world.”

amfAR’s Chris Collins co-authored
a “call to action” in The Lancet issue
that focused on the urgency of addressing HIV among MSM on both public health
and human rights grounds. Referring to that article at the NYAS
conference, Collins emphasized the important role that gay people have played
as advocates for all people affected
by HIV, as well as the irony that they are now being excluded from global AIDS
agendas.

“From the epidemic’s beginning,
gay men and lesbians have been at the forefront of advocacy around HIV,” said
Collins. “And that advocacy has been aimed to advance the whole HIV agenda to
address multiple populations.”

“But
gay HIV advocacy has also had a price all over the world. Advocacy efforts have
at times resulted in significant backlash and many activists have been beaten,
arrested, and killed when they’ve come forward demanding their rights. And for
every arrest and death that we know about, there are surely hundreds that we
don’t know about…And yet gay people remain generally underrepresented in making
decisions…We need better epidemiological studies and donors need to be sponsoring
that. We also need transparency about where the money’s going.”

Collins’
call to action is a strong appeal for more detailed research, more gay people
involved in HIV policy-related decision-making, and targeted donations support for
HIV among MSM. “We know there has been gross underinvestment in the HIV-related
needs of gay people in countries all over the world,” Collins said. “And that
goes for donor investments, which have, until recently, largely ignored the
needs of gay people.”

“The science is now teaching us
that the expanding HIV epidemic among MSM, and their disproportionately higher
rates of infection, is not solely about individual risk behaviors but also
biological dynamics that place MSM at significantly higher risk of infection
than heterosexual men and women,” said Collins. “It’s imperative that we do
much better at reaching MSM with anti-retroviral prevention and treatment, and
develop new tools to turn the epidemic around in MSM.”